Common Medicare billing mistakes and how to avoid them

Introduction: Getting the Most Efficiency Out of Your Practice

One of the biggest challenges in PT practice is billing. Medicare billing can pose an additional challenge. While Medicare is one system, it is managed by different providers. Billing codes change, even when providers do not. Billing protocols can be wildly different among different providers. The billing units are reimbursed in different amounts. All of this can lead to billing mistakes that delay payment and make your practice less efficient.

There are ways to avoid the most common billing mistakes. If everyone in a practice follows some simple protocols, Medicare billing mistakes are much less likely to occur. Below are some of the most common mistakes and the best ways to avoid them.

Lack of a consistent documentation process leads to errors and inefficiencies.

Documentation is the most important part of billing, and the most important way to avoid billing errors. If there is no consistent documentation system, information that could approve a claim may not be submitted. That may lead to a denial, which leads to further delays.

Having a detailed pattern of documentation for each client

The most efficient way to avoid errors in documentation is to have a detailed, specific pattern in use for all clients. Patient insurance, the primary medical issue that led them to seek physical therapy, and the records of all past visits should be prioritized in any documentation. SPRY’s fast charting system allows anyone with access to bring up the patient being seen, along with all past visits and what is needed for those insurance claims.This information should be in a central source and be able to be accessed quickly at each visit. When all of these are in place, PT appointments are quicker and lead to more satisfied patients.

Staff not being fully informed of Medicare policies and documentation requirements.

Everyone on the staff of a physical therapy practice needs to know Medicare policies and what documentation is needed for billing. If even one person isn’t sure of the correct protocol, they may not document important information needed for Medicare billing. This increases the rate of claim denials, and makes your practice less efficient.

Keep staff informed of policies and documentation needs

Staff should always be aware of the documentation Medicare needs to approve a claim and the billing policies that come with Medicare providers. Any time this information changes, they should be updated.

The staff of a PT practice are just as important to efficiency as the therapists themselves. To make your practice more efficient, your staff need to all be on the same page. They should know what should be documented about patients, where to find this information and where to update it, and any other information that needs to be recorded.

All staff should know policies and procedures related to patients or other important information. Most importantly, they should know any goals that you have set to either grow your practice or improve billing efficiency. Once staff knows those goals, they can work together and help you reach them.

SPRY’s automated billing software gives all staff a common form to handle Medicare claims and will prompt the user for what is missing if something is left out. It also offers quick checks of insurance eligibility so you know in advance what a claim might need.

Lack of clear goals leads to missed opportunities for growth and inefficiencies.

If you want a more efficient practice, you need to set specific goals towards that. If Medicare claim denials and billing errors are part of that problem, you need to have goals related to improving those problems. Once you know what areas you want to focus on, figure out a way to track those goals and see how often they are reached.

Give your practice specific goals to follow and track their success/growth patterns

Like with policy and documentation, if all staff know what the practice goals are they are easier for everyone to work towards. Goals should primarily relate to growing your practice and helping to make it more efficient. Medicare-specific goals can be set to make sure that you and your staff are working to avoid the most common Medicare billing errors.

Regular assessments are most important to checking if goals have been met. If they have not yet been met but are still improving, whatever is working should continue. If the success rates are not increasing from the goals, they should be reassessed and modified or substituted for a new set of goals.

The analytic system SPRY offers gives you an overview of your practice’s performance and can be a quick way to check whether those goals have been met.

Not checking for changes in patient insurance results in delays and denied claims.

Even Medicare policies change over time. If staff are not kept up to date on changes in patient insurance, including Medicare, claims may be denied because the protocol has changed. Tracking down the reasons for denied claims and ensuring they get reimbursed not only takes up time, but decreases profits.

Have patient insurance be checked regularly for any changes in insurance policy

If patient insurance information is kept up to date, and what claims need to be made for that insurance provider to reimburse are also available, that reduces those delays. Even if there is a denied claim, knowing what exactly is in place for insurance to typically approve them makes the process of appealing the denial simpler. SPRY’s system automatically updates insurance needs so there is no chance that changes in Medicare will be missed.

Neglecting patient satisfaction and conversion rates from potential clients.

Satisfied patients are one of your biggest sources of growth. If they are happy with their PT experience they will leave good online reviews and tell people they know about your practice. It’s also important to know how often potential clients decide to work with you and the reasons they have for choosing your practice.

Track patient satisfaction and how often potential clients become patients

When you track what patients are most satisfied by and what works the best with their needs you can make sure those areas are focused on as part of your goals. SPRY offers an analytics system that can track patient satisfaction and gives you concrete examples of potential goals. Likewise, knowing what potential patients want and how often they become clients gives you an easy source of further goals.

Underutilizing Practice Management Software (PMS) results in missed efficiency gains.

One crucial part of a more efficient practice is the maximum use of your PMS program. The best of these programs can help you with your goals by tracking them in a program.

Make sure you are getting all you can get/use from your PMS program

Staff can be trained on the same systems and can track those goals along with any providers. To do so, find out what features your program offers and see if you are implementing them or not. SPRY offers a free demo that can show everyone in your practice all the features it has available and how to use them.

Conclusion: Efficiency helps grow your practice

If Medicare billing claims are dealt with in an effective manner, delays from billing errors will decrease. Decreasing the rate of those errors leads your practice to be more efficient, which will increase growth and profit. Because of that, it’s important to know the ways billing errors affect your practice and ways to reduce them.